Overview

Population Characteristics

  • This dataset include 463 confirmed cases admitted from 2018-08-05 to 2019-07-15.

  • 56% women and 2% children ≤5 years .

  • 150 confirmed deaths reported for an average CFR of 32%.

Sampling

Cases Description

Admission Delay by Outcome

Time from Onset to Admission by Outcome
Outcome N Mean (days) Median (days) IQR (days)
Deceased 147 6.1 5.0 4.5
Recovered 253 4.2 3.0 4.0

Ct kinetics

  • A linear mixed-effects model with random intercepts per participant showed that Ct values significantly increased over time (β = 0.25, p < 0.001), consistent with viral load decline.
  • Participants who died had markedly lower baseline Ct values compared to recovered individuals (β = −8.65, p < 0.001), indicating higher initial viral loads.
  • The interaction between time and outcome was not significant (p = 0.60), suggesting similar Ct kinetics across outcomes.

\[ Ct_{ij} = \beta_0 + \beta_1 (\text{Time from Onset}_{ij}) + \beta_2 (\text{Outcome}_i) + \beta_3 (\text{Time from Onset} \times \text{Outcome}_i) + u_i + \epsilon_{ij} \]

  • (Ct_{ij}): Ct value for participant i at time j
  • (_0): intercept (baseline Ct for recovered)
  • (_1): daily Ct change among recovered
  • (_2): baseline difference (Death vs Recovered)
  • (_3): interaction (difference in Ct trajectory)
  • (u_i): random intercept
  • (_{ij}): residual error

Cases and CFR

Treatments and complications

These complications are inferred from laboratory results :

  • Renal impairment: Creatinine (mg/dL)≥1.1
  • Hyperkaliemia: Potassium (mmol/L)>5.5
  • Hypokaliemia: Potassium (mmol/L)<3.5
  • Rhabdomyolysis: Creatinine kinase (U/L)>1000
  • Severe hypoglycemia: Glucose (mg/dL) <60
  • Severe thrombocytopenia: Platelets (x10⁹/L) <50

Analyses

Proposed Causal DAG of Ebola pathophysiology and outcomes

flow ImmuneMod Immune modulation DelDirect Deleterious direct effect of virus ImmuneMod->DelDirect +/- ViralLoad Viral load ViralLoad->DelDirect + OrganFail Organ failure DelDirect->OrganFail + Death Death OrganFail->Death + PreExist Pre-existing comorbidity PreExist->OrganFail + Age Age Age->PreExist +/- Sex Sex Sex->PreExist DelayedPres Delayed presentation Sex->DelayedPres Nutrition Nutrition Nutrition->PreExist + DelayedPres->ViralLoad + Vaccination Vaccination Vaccination->ViralLoad - Antiviral Antiviral therapy Antiviral->ViralLoad - Hypoperf Hypoperfusion / shock Hypoperf->OrganFail + Dehydration Dehydration Dehydration->Hypoperf + MetElect Metabolic / electrolyte derangement Dehydration->MetElect + MetElect->OrganFail + Hypoxa Hypoxaemia Hypoxa->OrganFail + Anemia Anaemia Anemia->Hypoxa + SecInf Secondary infection SecInf->OrganFail + SecInf->Hypoxa + Bleeding Bleeding Bleeding->Anemia + ORS ORS ORS->Dehydration - IVfluid IV fluid IVfluid->Dehydration - IVfluid->MetElect - Diarrhoea Diarrhoea Diarrhoea->Dehydration +

Ct threshold to predict participant outcome

  • ROC analyses were performed to determine the optimal Ct threshold to predict participant outcome.
  • With an area under the curve (AUC) of 0.85, ROC analyses evaluated the optimal Ct threshold cut-off at 23.25 for predicting patients outcome (sensitivity 79%, specificity 77%).

Logistic Regression of Factors Associated with Death and Complications

Final LASSO-selected Logistic Regression: EVD Outcome
Characteristic N n_obs Event N OR 95% CI p-value Significance1 Direction
CT at admission 354 354 134 0.69 0.63, 0.76 <0.001 *** ⬇
Delay from admission 354 354 134 1.13 1.03, 1.24 0.009 ** ⬆
    Remdesivir (GS-5734)
112
5.13 1.40, 18.7 0.013 * ⬆
    Zmapp
22
13.1 2.10, 81.8 0.006 ** ⬆
    Difficulty breathing anytime
43
5.00 1.66, 15.1 0.004 ** ⬆
    Fatigue/weakness anytime
302
3.65 1.02, 13.0 0.046 * ⬆
    Signs of dehydration anytime
40
0.29 0.09, 0.92 0.036 * ⬇
Abbreviations: CI = Confidence Interval, OR = Odds Ratio
1 Odds ratios (OR) obtained by exponentiating the logistic regression coefficients (β). OR > 1 indicates increased odds of the outcome; OR < 1 indicates decreased odds.
  • Only significant predictors are shown.
Final LASSO-selected Logistic Regression: Renal Impairment
Characteristic N n_obs Event N OR 95% CI p-value Significance1 Direction
Ebola treatment 354
40




    None
28
— —


    REGN3470-3471-3479
111
2.88 0.45, 58.7 0.35 ⬆
    Remdesivir (GS-5734)
112
1.07 0.14, 22.6 0.96 ⬆
    Zmapp
22
1.29 0.09, 35.8 0.86 ⬆
    mAb114
79
0.77 0.09, 17.2 0.83 ⬇
    REGN3470-3471-3479, Remdesivir (GS-5734)
1
0.00
>0.99 ⬇
    mAb114, Remdesivir (GS-5734)
1
0.00
>0.99 ⬇
Total NaCl administered 354 354 40 1.00 1.00, 1.00 0.067 . ⬆
Experimental treatment 354
40




    No
209
— —


    Yes
145
2.74 1.16, 6.73 0.024 * ⬆
Hyperkaliemia 354
40




    No
347
— —


    Yes
7
19.7 2.15, 219 0.009 ** ⬆
hypokaliemia 354
40




    No
344
— —


    Yes
10
12.5 2.46, 58.9 0.001 ** ⬆
rhabdomyolysis 354
40




    No
335
— —


    Yes
19
41.5 12.2, 166 <0.001 *** ⬆
Severe Hypoglycemia 354
40




    No
348
— —


    Yes
6
20.1 1.70, 239 0.015 * ⬆
Abbreviations: CI = Confidence Interval, OR = Odds Ratio
1 Odds ratios (OR) obtained by exponentiating the logistic regression coefficients (β). OR > 1 indicates increased odds of the outcome; OR < 1 indicates decreased odds.

Survival Analyses

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